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Sklansky M, Afshar Y, Anton T, DeVore GR, Platt L, Satou G. Guidance for fetal cardiac imaging in patients with degraded acoustic windows. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:709-712. [PMID: 35118748 DOI: 10.1002/uog.24872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Affiliation(s)
- M Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Y Afshar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - T Anton
- Department of Reproductive Medicine, University of California, San Diego, CA, USA
| | - G R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
- Fetal Diagnostic Centers, Pasadena, Tarzana and Lancaster, CA, USA
| | - L Platt
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
- Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA, USA
| | - G Satou
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Clerici G, Romanelli M, Tosto V, Tsibizova V, Di Renzo GC. Fetal transient tricuspid valve regurgitation: sonographic features and clinical evolution. J Matern Fetal Neonatal Med 2019; 34:2435-2439. [PMID: 31550963 DOI: 10.1080/14767058.2019.1667326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To analyze the prevalence, the sonographic features, the clinical evolution and significance of fetal tricuspid valve regurgitation (TR). STUDY DESIGN This is a prospective study. Serial ultrasound examinations were performed at 20-23, at 26-29 and at 30-34 gestational weeks in 675 consecutive singleton pregnancies with fetal normal growth and normal cardiac anatomy. The fetal tricuspid valve regurgitation was classified according to its duration, to the peak of jet maximum velocity and to its maximum spatial extension. A clinical examination and echocardiography were performed in neonates after birth. RESULTS During the first examination (20-23 weeks), 32 cases of tricuspid valve regurgitation were identified. The prevalence of tricuspid regurgitation was 4.74%. The large majority of TR cases were not-holosystolic (87.5%), with a maximum velocity below 2 m/sec (80-130 cm/sec in 84% cases and 180-200 cm/sec in 16% cases) and with a little spatial extension (type I or II in 87.5% cases). Following this hemodynamic phenomenon during the following weeks, we found that it disappeared around 29 weeks in all cases. CONCLUSIONS Tricuspid regurgitation observed during the second trimester can be considered a transient and functional hemodynamic phenomenon, without apparent pathological significance.
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Affiliation(s)
- Graziano Clerici
- European Medical and Research Center (CEMER), University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
| | - Maila Romanelli
- European Medical and Research Center (CEMER), University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Valentina Tosto
- Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | | | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia.,Department of Obstetrics and Gynaecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
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Abstract
Congenital cardiac anomalies are a common finding during prenatal anatomical survey ultrasound examination. Cardiac anomalies are a major cause of prenatal and neonatal mortality and morbidity. If the anomaly is not lethal, most would require surgical correction. Therefore, early recognition of these abnormalities is essential for parental counseling and delivery planning, as well as analysis of neonatal treatment options. Although prenatal ultrasound plays an important role in identification of such anomalies, diagnosis and interpretation of imaging findings require familiarity and knowledge of the common imaging features. In this article, we provide a comprehensive review of ultrasound appearance of common fetal cardiac anomalies.
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Yeo L, Romero R. Color and power Doppler combined with Fetal Intelligent Navigation Echocardiography (FINE) to evaluate the fetal heart. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:476-491. [PMID: 28809063 PMCID: PMC5656930 DOI: 10.1002/uog.17522] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/23/2017] [Accepted: 03/03/2017] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To evaluate the performance of color and bidirectional power Doppler ultrasound combined with Fetal Intelligent Navigation Echocardiography (FINE) in examining the fetal heart. METHODS A prospective cohort study was conducted of fetuses in the second and third trimesters with a normal heart or with congenital heart disease (CHD). One or more spatiotemporal image correlation (STIC) volume datasets, combined with color or bidirectional power Doppler (S-flow) imaging, were acquired in the apical four-chamber view. Each successfully obtained STIC volume was evaluated by STICLoop™ to determine its appropriateness before applying the FINE method. Visualization rates for standard fetal echocardiography views using diagnostic planes and/or Virtual Intelligent Sonographer Assistance (VIS-Assistance®) were calculated for grayscale (removal of Doppler signal), color Doppler and S-flow Doppler. In four cases with CHD (one case each of tetralogy of Fallot, hypoplastic left heart and coarctation of the aorta, interrupted inferior vena cava with azygos vein continuation and asplenia, and coarctation of the aorta with tricuspid regurgitation and hydrops), the diagnostic potential of this new technology was presented. RESULTS A total of 169 STIC volume datasets of the normal fetal heart (color Doppler, n = 78; S-flow Doppler, n = 91) were obtained from 37 patients. Only a single STIC volume of color Doppler and/or a single volume of S-flow Doppler per patient were analyzed using FINE. Therefore, 60 STIC volumes (color Doppler, n = 27; S-flow Doppler, n = 33) comprised the final study group. Median gestational age at sonographic examination was 23 (interquartile range, 21-27.5) weeks. Color Doppler FINE generated nine fetal echocardiography views (grayscale) using (1) diagnostic planes in 73-100% of cases, (2) VIS-Assistance in 100% of cases, and (3) a combination of diagnostic planes and/or VIS-Assistance in 100% of cases. The rate of generating successfully eight fetal echocardiography views with appropriate color and S-flow Doppler information was 89-100% and 91-100% of cases, respectively, using a combination of diagnostic planes and/or VIS-Assistance. However, the success rate for the ninth echocardiography view (i.e. superior and inferior venae cavae) was 33% and 30% for color and S-flow Doppler, respectively. In all four cases of CHD, color Doppler FINE demonstrated evidence of abnormal fetal cardiac anatomy and/or hemodynamic flow. CONCLUSIONS The FINE method applied to STIC volumes of normal fetal hearts acquired with color or bidirectional power Doppler information can generate successfully eight to nine standard fetal echocardiography views (via grayscale, color Doppler or power Doppler) in the second and third trimesters. In cases of CHD, color Doppler FINE demonstrates successfully abnormal anatomy and/or Doppler flow characteristics. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L. Yeo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNIHBethesdaMD and Detroit, MIUSA
- Detroit Medical CenterHutzel Women's HospitalDetroitMIUSA
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMIUSA
| | - R. Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNIHBethesdaMD and Detroit, MIUSA
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMIUSA
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMIUSA
- Center for Molecular Medicine and GeneticsWayne State UniversityDetroitMIUSA
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Garg S, Sharma P, Sharma D, Behera V, Durairaj M, Dhall A. Use of fetal echocardiography for characterization of fetal cardiac structure in women with normal pregnancies and gestational diabetes mellitus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1365-1369. [PMID: 25063401 DOI: 10.7863/ultra.33.8.1365] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To assess fetal cardiac structure and function and to evaluate the efficacy of routine fetal echocardiography for detection of fetal cardiac abnormalities in women with normal pregnancies and those with gestational diabetes mellitus. METHODS In this prospective study, we studied fetal cardiac structure and function in 294 uncomplicated singleton pregnancies and 302 pregnancies complicated by gestational diabetes. Fetal echocardiography (2-dimensional sonography and pulsed wave Doppler imaging) was used to assess functional parameters and to detect any cardiac structural abnormality. Data from clinical and echocardiographic evaluations of neonates at birth and 3 months were obtained to confirm the antenatal findings. RESULTS The mean maternal age ± SD was 28.9 ± 5.0 years in the diabetes group and was comparable to that of women with normal pregnancies. The mean hemoglobin A1c value was 6.3%, and the mean body mass index was 28.0 kg/m(2). The systolic function as assessed by the ejection fraction increased significantly in the diabetes group compared to the normal pregnancy group independent of glycemic control (P < .001). The pulsed wave parameters (early diastolic peak flow velocity and early-to-late diastolic peak flow velocity ratio) were significantly different between the groups (P < .001). The interventricular septum and fetal ventricular wall thicknesses were significantly increased in the presence of gestational diabetes (P < .001). No major fetal cardiac structural anomaly was detected in either group. On follow-up after delivery, all neonates were assessed clinically and by transthoracic echocardiography to rule out congenital defects. CONCLUSIONS In our study, significant increases in the interventricular septum and ventricular wall thicknesses were detected in the presence of gestational diabetes mellitus. Interestingly, none of the neonates of pregnant women with gestational diabetes were found to have echocardiographic evidence of congenital heart disease.
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Affiliation(s)
- Salil Garg
- Command Hospital, Lucknow, India (S.G.); Department of Medicine, Armed Forces Medical College, Pune, India (P.S., V.B.); Department of Cardiology, Ulster Hospital, Belfast, Northern Ireland (D.S.); Ruby Hall Clinic, Grant Medical Foundation, Pune, India (M.D.); and Department of Cardiology, Artemis Health Institute, Gurgaon, India (A.D.)
| | - Prafull Sharma
- Command Hospital, Lucknow, India (S.G.); Department of Medicine, Armed Forces Medical College, Pune, India (P.S., V.B.); Department of Cardiology, Ulster Hospital, Belfast, Northern Ireland (D.S.); Ruby Hall Clinic, Grant Medical Foundation, Pune, India (M.D.); and Department of Cardiology, Artemis Health Institute, Gurgaon, India (A.D.).
| | - Divyesh Sharma
- Command Hospital, Lucknow, India (S.G.); Department of Medicine, Armed Forces Medical College, Pune, India (P.S., V.B.); Department of Cardiology, Ulster Hospital, Belfast, Northern Ireland (D.S.); Ruby Hall Clinic, Grant Medical Foundation, Pune, India (M.D.); and Department of Cardiology, Artemis Health Institute, Gurgaon, India (A.D.)
| | - Vineet Behera
- Command Hospital, Lucknow, India (S.G.); Department of Medicine, Armed Forces Medical College, Pune, India (P.S., V.B.); Department of Cardiology, Ulster Hospital, Belfast, Northern Ireland (D.S.); Ruby Hall Clinic, Grant Medical Foundation, Pune, India (M.D.); and Department of Cardiology, Artemis Health Institute, Gurgaon, India (A.D.)
| | - Manuel Durairaj
- Command Hospital, Lucknow, India (S.G.); Department of Medicine, Armed Forces Medical College, Pune, India (P.S., V.B.); Department of Cardiology, Ulster Hospital, Belfast, Northern Ireland (D.S.); Ruby Hall Clinic, Grant Medical Foundation, Pune, India (M.D.); and Department of Cardiology, Artemis Health Institute, Gurgaon, India (A.D.)
| | - Anil Dhall
- Command Hospital, Lucknow, India (S.G.); Department of Medicine, Armed Forces Medical College, Pune, India (P.S., V.B.); Department of Cardiology, Ulster Hospital, Belfast, Northern Ireland (D.S.); Ruby Hall Clinic, Grant Medical Foundation, Pune, India (M.D.); and Department of Cardiology, Artemis Health Institute, Gurgaon, India (A.D.)
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Zhou Q, Ren Y, Yan Y, Chu C, Gui Y, Li X. Fetal tissue Doppler imaging in pregnancies complicated with preeclampsia with or without intrauterine growth restriction. Prenat Diagn 2012; 32:1021-8. [PMID: 22903327 DOI: 10.1002/pd.3948] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study's aim was to evaluate the effect of preeclampsia and intrauterine growth restriction (IUGR) on fetal cardiac function, and the relationship of the latter with adverse pregnancy outcomes. MATERIAL AND METHODS We did a cross-sectional study of 132 women with uncomplicated singleton pregnancies, 34 with preeclampsia without IUGR, and 12 with preeclampsia and IUGR. Fetal cardiac structure and function were evaluated using fetal two-dimension ultrasound, pulsed wave Doppler and tissue Doppler imaging (TDI). Data were analyzed by t-tests, ANOVA, Chi-square tests, or Wilcoxon rank-sum test. RESULTS Compared with the normal pregnancy group, mitral/tricuspid early systolic peak velocity of annulus/late diastolic peak velocity of annulus (Sa) and left ventricular (LV)/right ventricular (RV) early diastolic peak velocity at the annulus (Ea) in TDI decreased in preeclampsia with or without IUGR (P < 0.05). LV/RV Ea underwent a gestational decrease in preeclampsia with or without IUGR (P < 0.05). The changes in mitral/tricuspid Sa and LV Sa associated with preeclampsia were even more pronounced with preterm delivery at less than 34 gestational weeks and stillbirth (P < 0.05). CONCLUSIONS Intrauterine growth restriction influences fetal cardiac function in the presence of preeclampsia, and TDI may be a sensitive and preferable method to detect such changes. Fetal LV/RV Ea is a potential marker for early fetal cardiac diastolic impairment, and mitral/tricuspid Sa and LV Sa may be predictors for adverse pregnancy outcomes.
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Affiliation(s)
- Qiongjie Zhou
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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Ren Y, Zhou Q, Yan Y, Chu C, Gui Y, Li X. Characterization of fetal cardiac structure and function detected by echocardiography in women with normal pregnancy and gestational diabetes mellitus. Prenat Diagn 2011; 31:459-65. [DOI: 10.1002/pd.2717] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 01/12/2011] [Accepted: 01/13/2011] [Indexed: 11/08/2022]
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Sklansky M. Current guidelines for fetal echocardiography: time to raise the bar. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:284-286. [PMID: 21266571 DOI: 10.7863/jum.2011.30.2.284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Yu Q, Leatherbury L, Tian X, Lo C. Cardiovascular assessment of fetal mice by in utero echocardiography. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:741-52. [PMID: 18328616 PMCID: PMC4275222 DOI: 10.1016/j.ultrasmedbio.2007.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 09/27/2007] [Accepted: 11/01/2007] [Indexed: 05/10/2023]
Abstract
To establish a developmental profile of fetal mouse cardiovascular parameters, we analyzed a large body of ultrasound measurements obtained by in utero echocardiography of C57BL/6J fetal mice from embryonic day 12.5 to 19.5 (term). Measurements were obtained using two-dimensional (2D), spectral Doppler and M-mode imaging with standard clinical cardiac ultrasound imaging planes. As these studies were conducted as part of a large scale mouse mutagenesis screen, stringent filtering criteria were used to eliminate potentially abnormal fetuses. Our analysis showed heart rate increased from 190 to 245 beats per minute as the mouse fetus grew from 8 mm at embryonic day 12.5 to 18.7 mm at term. This was accompanied by increases in peak outflow velocity, E-wave, E/A ratio and ventricular dimensions. In contrast, the A-wave, myocardial performance index and isovolemic contraction time decreased gradually. Systolic function remained remarkably stable at 80% ejection fraction. Analysis of intra- and interobserver variabilities showed these parameters were reproducible, with most comparing favorably to clinical ultrasound measurements in human fetuses. A comprehensive database was generated comprising 23 echocardiographic parameters delineating fetal mouse cardiovascular function from embryonic day 12.5 to term. This database can serve as a standard for evaluating cardiovascular pathophysiology in genetically altered and mutant mouse models.
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Affiliation(s)
- Qing Yu
- Laboratory of Developmental Biology, National Heart Lung and Blood Institute, Bethesda, Maryland
| | - Linda Leatherbury
- Laboratory of Developmental Biology, National Heart Lung and Blood Institute, Bethesda, Maryland
- Children’s National Heart Institute, Children’s National Medical Center, Washington, D.C
| | - Xin Tian
- Office of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, Maryland
| | - C.W. Lo
- Laboratory of Developmental Biology, National Heart Lung and Blood Institute, Bethesda, Maryland
- Address for correspondence: Dr. Cecilia Lo, 9000 Rockville Pike, NIH/NHLBI/LDB, Buidling 50/Room 4537, Bethesda, MD 20892. Telephone: 301-451-8041. FAX: 301-480-4581.
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Shen Y, Leatherbury L, Rosenthal J, Yu Q, Pappas MA, Wessels A, Lucas J, Siegfried B, Chatterjee B, Svenson K, Lo CW. Cardiovascular phenotyping of fetal mice by noninvasive high-frequency ultrasound facilitates recovery of ENU-induced mutations causing congenital cardiac and extracardiac defects. Physiol Genomics 2006; 24:23-36. [PMID: 16174781 DOI: 10.1152/physiolgenomics.00129.2005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As part of a large-scale noninvasive fetal ultrasound screen to recover ethylnitrosourea (ENU)-induced mutations causing congenital heart defects in mice, we established a high-throughput ultrasound scanning strategy for interrogating fetal mice in utero utilizing three orthogonal imaging planes defined by the fetus’ vertebral column and body axes, structures readily seen by ultrasound. This contrasts with the difficulty of acquiring clinical ultrasound imaging planes which are defined by the fetal heart. By use of the three orthogonal imaging planes for two-dimensional (2D) imaging together with color flow, spectral Doppler, and M-mode imaging, all of the major elements of the heart can be evaluated. In this manner, 10,091 ENU-mutagenized mouse fetuses were ultrasound scanned between embryonic days 12.5 and 19.5, with 324 fetuses found to die prenatally and 425 exhibiting cardiovascular defects. Further analysis by necropsy and histology showed heart defects that included conotruncal anomalies, obstructive lesions, and shunt lesions as well as other complex heart diseases. Ultrasound imaging also identified craniofacial/head defects and body wall closure defects, which necropsy revealed as encephalocele, holoprosencephaly, omphalocele, or gastroschisis. Genome scanning mapped one ENU-induced mutation associated with persistence truncus arteriosus and holoprosencephaly to mouse chromosome 2, while another mutation associated with cardiac defects and omphalocele was mapped to mouse chromosome 17. These studies show the efficacy of this novel ultrasound scanning strategy for noninvasive ultrasound phenotyping to facilitate the recovery of ENU-induced mutations causing congenital heart defects and other extracardiac anomalies.
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Affiliation(s)
- Yuan Shen
- Laboratory of Developmental Biology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-8019, USA
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Current awareness in prenatal diagnosis. Prenat Diagn 2004; 24:937-42. [PMID: 15587482 DOI: 10.1002/pd.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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